Butrans® (buprenorphine) Transdermal System CIII

Initial Dosing

Initiate the dosing regimen for each patient individually, taking into account the patient's prior analgesic treatment experience and risk factors for addiction, abuse, and misuse. Monitor patients closely for respiratory depression, especially within the first 24–72 hours of initiating therapy with Butrans. Butrans should be prescribed only by healthcare professionals who are knowledgeable in the use of potent opioids for the management of chronic pain.

Butrans doses of 7.5, 10, 15, and 20 mcg/hour are for opioid-experienced patients only.

Butrans is for transdermal use (on intact skin) only. Each Butrans patch is intended to be worn for 7 days.

Instruct patients not to use Butrans if the pouch seal is broken or the patch is cut, damaged, or changed in any way and not to cut Butrans.

Discontinue all other around-the-clock opioid drugs when Butrans therapy is initiated.

*Patients using fentanyl transdermal system or extended-release hydromorphone for pain control were excluded from the pivotal Butrans clinical trial with opioid-experienced patients whose opioid daily dose prior to enrollment was between 30 and 80 mg morphine equivalents.

Select the total daily dose of :

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Select an opioid medication*:

Select the total daily dose of :

The selected dose corresponds to a prior total daily dose of <30 mg of oral morphine equivalents per day
Recommended starting dose of Butrans for this patient is:

The selected dose corresponds to a prior total daily dose of between 30–80 mg of oral morphine equivalents per day
Recommended starting dose of Butrans for this patient is:

Taper the patient's current around-the-clock opioids for up to 7 days to no more than 30 mg of morphine or equivalent per day before beginning treatment with Butrans.

The selected dose corresponds to a prior total daily dose of >80 mg of oral morphine equivalents per day
Recommended starting dose of Butrans for this patient is:

Do not exceed a dose of one 20 mcg/hour Butrans system due to the risk of QTc interval prolongation.

The highest Butrans dosage of 20 mcg/hour may not provide adequate analgesia for patients requiring the selected opioid daily dose. Consider use of an alternate analgesic.

Select an opioid medication*:

Select the total daily dose of :

The selected dose corresponds to a prior total daily dose of <30 mg of oral morphine equivalents per day Recommended starting dose of Butrans for this patient is:

The selected dose corresponds to a prior total daily dose of between 30–80 mg of oral morphine equivalents per day Recommended starting dose of Butrans for this patient is:

Taper the patient's current around-the-clock opioids for up to 7 days to no more than 30 mg of morphine or equivalent per day before beginning treatment with Butrans.

The selected dose corresponds to a prior total daily dose of >80 mg of oral morphine equivalents per day Recommended starting dose of Butrans for this patient is:

Do not exceed a dose of one 20 mcg/hour Butrans system due to the risk of QTc interval prolongation.

The highest Butrans dosage of 20 mcg/hour may not provide adequate analgesia for patients requiring the selected opioid daily dose. Consider use of an alternate analgesic.

The selected dose corresponds to a prior total daily dose of <30 mg of oral morphine equivalents per day
Recommended starting dose of Butrans for this patient is:

The selected dose corresponds to a prior total daily dose of between 30–80 mg of oral morphine equivalents per day
Recommended starting dose of Butrans for this patient is:

The selected dose corresponds to a prior total daily dose of >80 mg of oral morphine equivalents per day
Recommended starting dose of Butrans for this patient is: